Patients with major depressive disorder (MDD) who are treated with antidepressant medications often report weight gain as a side effect. The combination of citalopram and Wellbutrin (bupropion) for the treatment of depression is a relatively common practice. However, the effects of this combination on weight can be complex and vary significantly from person to person. This article aims to provide a comprehensive overview of the potential effects of citalopram and Wellbutrin on weight, drawing upon research studies, clinical observations, and personal experiences.
Understanding the Medications
Citalopram
Citalopram, also known by the brand name Celexa, is a selective serotonin reuptake inhibitor (SSRI). Celexa is an SSRI, since St. John's Wort is also an SSRI and it helped some patients in the past. SSRIs primarily work by increasing the levels of serotonin in the brain.
Wellbutrin
Wellbutrin, or bupropion, is an aminoketone antidepressant that acts as a norepinephrine and dopamine reuptake inhibitor (NDRI). Bupropion's unique clinical profile leading to dual norepinephrine and dopamine reuptake inhibition, devoid of serotonergic effects alleviates bupropion from the common side effects of older antidepressants, thereby accounting for the weight loss. It is also used for smoking cessation under the name Zyban.
Weight Changes: What the Research Says
Weight gain as an adverse effect of monotherapy of antidepressant has been well-studied. Body weight changes, in particular weight gain, has been associated in multiple studies with the use of antidepressants.
Citalopram and Weight Gain
Hi unfortunately weight gain is a very common side effect of Citalopram and many antidepressants. Several studies have indicated that SSRIs like citalopram can be associated with weight gain. The mechanism of action behind the therapeutic effects and side effects of SSRIs have been well described. SSRIs target the negative allosteric regulation of serotonin reuptake pump, increasing serotonin concentration in specific regions which impacts other physiological functions like appetite, sleep and sexual function. A study using electronic health records found that relative to sertraline, weight change at 6 months was higher for escitalopram (0.41 kg), duloxetine (0.34 kg), paroxetine (0.37 kg), and venlafaxine (0.17 kg).
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Wellbutrin and Weight Loss
On the contrary, bupropion of the aminoketone class has been consistently associated with weight neutral to modest weight loss effects. Some weight loss was found to occur with fluoxetine and bupropion. Weight loss associated with bupropion was observed during acute and maintenance treatment whereas that for fluoxetine was seen only during acute treatment. If weight loss occurs during long-term bupropion treatment, this medication may be a preferred option for some patients. Blumenthal and colleagues report a pharmacoepidemiological analysis using electronic health records from the Partners HealthCare electronic record, a database containing data from hospitals as well as from community and specialty outpatient clinics that comprise the Partners HealthCare system in Boston, Massachusetts. The literature is consistent in identifying bupropion as an antidepressant that is less likely to cause weight gain than other antidepressants.
Citalopram and Wellbutrin Combination
Studying the comedication effects of bupropion with the most commonly prescribed antidepressants, SSRIs, can be particularly beneficial. It can help us design weight management strategies for depression patients, promote greater compliance to antidepressant therapy and prevent metabolic comorbidities as a consequence of adverse weight gain.
A study examined the effects of combining bupropion with several SSRIs, including citalopram. Six individual models were built for each of the six antidepressants, namely escitalopram, sertraline, citalopram, fluoxetine, paroxetine and duloxetine. Each antidepressant model included three cohorts of patients, where ‘X’ refers to the respective antidepressant: (i) a cohort on ‘X’ for at least 180 days, but not on bupropion; (ii) a cohort on bupropion for at least 180 days, but not on ‘X’; and (iii) a cohort on ‘X’ and bupropion concurrently for at least 180 days. Weight changes were measured by the differences between ‘treatment BMI’ and ‘baseline BMI’. In the model, with patients on the citalopram treatment having the highest increase (0.49), followed by those on combination treatment (0.44). The post hoc tests showed that the sertraline cohort had significantly higher BMI increase than the bupropion cohort (p < 0.001). The other significant covariate was baseline BMI (p = 0.0178). The study found that the increase in BMI, in five of the comedication cohort was not significantly different from their respective SSRI/SNRI monotherapy. Interestingly, the comedication of escitalopram and bupropion showed a significant increase in BMI from baseline that was significantly higher than the BMI increase on monotherapy. This finding is of high clinical importance as each unit increase in BMI, especially in the 25-45 kg/m category, can substantially increase the likelihood for diabetes and heart diseases and also contribute to soaring healthcare costs.
Personal Experiences
The information on this page reflects personal experiences shared by our community members. I understand this was originally posted in 2012…Personal experiences with citalopram and Wellbutrin vary widely. Some individuals report weight gain when taking citalopram, even when combined with Wellbutrin. I've gained 35lbs in 18 months and feel worse than ever!! Now I'm really depressed and feeling worse than I did since the beginning of it all. My self esteem is horrible. I'm trying to wean off the citalopram desperately. It's so hard because of the side effects of getting off it. I want to cry all the time, I can't focus, I'm shaky, and I can't sleep. Others report no weight gain or even weight loss. I did not gain any weight when I began taking celexa along with Wellbutrin. The Wellbutrin is good for controlling a variety of cravings. When I was on Citalopram I lost 50 pounds, Wellbutrin has done nothing for weight loss for me.
Factors Influencing Weight Changes
Several factors can influence weight changes when taking citalopram and Wellbutrin:
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Individual Metabolism and Body Chemistry
To LauriShay and Delila. I asked the pharmacist when getting the Citalopram and she said I can have a healthy diet and exercise regularly but still gain weight-caused by the serotonin and other body chemicals depending the person. Individual differences in metabolism and body chemistry play a significant role in how these medications affect weight.
Lifestyle Factors
Weight gain is relative to how you eat. While certain medications my increase your appetite it is up to you what goes into your stomach. Lifestyle factors such as diet and exercise habits can significantly impact weight. Regular physical activity and a balanced diet can help mitigate potential weight gain.
Dosage
I was initially put on Wellbutrin at 150mg and worked up to 450mg with no affect on depression but great for appetite control and energy. Dosage levels of both medications can influence their effects on weight.
Other Medications
I take Citalopram + Amitriptyline + Seroquel and i've gained a lot of weight. The use of other medications can interact with citalopram and Wellbutrin, affecting weight.
Important Considerations
Potential Drug Interactions
Talk to your doctor before using buPROPion together with citalopram. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of citalopram, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.
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Alcohol and Caffeine Interactions
You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Using buPROPion with alcohol may increase the risk of uncommon side effects such as seizures, hallucinations, delusions, paranoia, mood and behavioral changes, depression, suicidal thoughts, anxiety, and panic attacks. On the other hand, sudden withdrawal from alcohol following regular or chronic use can also increase your risk of seizures during treatment with buPROPion. If you are prone to frequent or excessive alcohol use, talk to your doctor before starting buPROPion. In general, you should avoid or limit the use of alcohol while being treated with buPROPion. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Alcohol can increase the nervous system side effects of citalopram such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with citalopram. Do not use more than the recommended dose of citalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Both buPROPion and caffeine can increase blood pressure. And using them together may have additive effects. Talk to your doctor if you have any questions or concerns, particularly if you have a history of high blood pressure or heart disease. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs.
Increased Risk of Seizures
Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual.
Suicidal Thoughts and Behaviors
Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider.
Strategies for Managing Weight
Weight management in depression patients is a crucial aspect of a well thought out treatment plan. Apart from promoting adherence to the therapy, weight management can help in keeping other metabolic comorbidities at bay. A prudent antidepression regimen can benefit from a careful selection of antidepressants based on individual drugs and comedication risk profiles, also taking into account anthropometric measures and baseline metabolic assessment.
Lifestyle Modifications
Maintaining a healthy diet and engaging in regular physical activity are essential for managing weight while on these medications. The Wellbutrin is good for controlling a variety of cravings.
Regular Monitoring
Regularly monitoring weight and BMI can help track any changes and address them proactively.
Consulting with Healthcare Professionals
Consulting with a doctor, nutritionist, or other healthcare professional can provide personalized strategies for managing weight.
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